Healthcare Provider Details

I. General information

NPI: 1144034992
Provider Name (Legal Business Name): LIVE LIFE IN FULL BLOOM TOO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 HANOVER GREEN DR STE A2
MECHANICSVILLE VA
23111-1764
US

IV. Provider business mailing address

2615 OAK HILL RD
PETERSBURG VA
23805-2425
US

V. Phone/Fax

Practice location:
  • Phone: 804-933-8357
  • Fax:
Mailing address:
  • Phone: 804-933-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE JANES
Title or Position: OWNER
Credential: QMHP-A, CSAC-A
Phone: 804-933-8357